Impact of CT in the neurosurgical management of intracranial tumors

Summary A total of 103 brain tumor patients examined with CT, radionuclide brain scan, and angiography or pneumoencephalography, and all surgically verified, were studied to evaluate the impact of CT on the neurosurgical handling of brain tumors. CT alone was usually sufficient for optimal handling of astrocytoma patients, angiography in most meningioma cases, and pneumoencephalography in cases with sellar, suprasellar, and some other midline tumors. Information obtained only through CT sometimes altered the therapy. Sometimes it led to biopsy instead of a meaningless attempt at a radical excision; in other cases it permitted a radical excision otherwise not possible.     

Intraoperative ultrasound examination of the brain

In a preliminary demonstration of cranial intraoperative real-time ultrasound, both supratentorial and posterior fossa scans displayed the pertinent anatomy. A grade III astrocytoma was visualized on the supratentorial scan as well. Ultrasound may be valuable for surgical planning and biopsy procedures because of its reliable depiction of intracranial anatomy and ease of use.     

Intraoperative ultrasound in pediatric neurosurgery

Intraoperative sonography is a useful tool for the neurosurgeon to achieve rapid orientation. This is of particular importance, since planning of an operation is usually based on standard cuts obtained via CT or MR, whereas surgical approach is governed by the prevailing anatomico-topographical conditions. The article reports on experience collected in the operation of intracranial tumors and cysts and in shunt implants effected in children and adults.     

Intraoperative ultrasound localization of nonpalpable breast cancers: A valuable aid during breast-conserving surgery

Objective

To evaluate the usefulness of intra-operative ultrasonography (US) for localization of nonpalpable breast cancer that could be visualized with preoperative US.

Patients and methods

We prospectively assessed 57 nonpalpable sonographically detected and biopsy-proved breast cancers in 57 patients. US localization of breast cancers was performed in the OR by the radiologist immediately before definitive surgery using either injection of blue dye or placement of a guide wire after marking of the skin overlying the lesion with a marking pen. Tumor identification, the correlation with tumor diameter on preoperative US, analysis of resection margins, and the need to perform surgical re-excision were analyzed.

Results

US correctly localized all lesions at surgery. Re-excision due to positive resection margins was necessary in four patients (7%) including three patients with ductal carcinoma-in situ (DCIS) and one patient with invasive disease at the surgical margin. Mastectomy was necessary in one patient (1.7%) due to multifocal invasive carcinoma. Thus, the re-excision rate was 8.7% (5 of 57).

Conclusion

US in the operating room is an attractive alternative guiding tool of localizing nonpalpable breast cancers that have been seen on preoperative US improving the process of image-guided surgery.     

Intraoperative abdominal ultrasound in oncologic imaging

Significant advances in ultrasound technology have created new opportunities for its use in oncologic imaging. The advent of new transducers with focal beam technology and higher frequency has solidified the role of intraoperative sonography (IOUS) as an invaluable imaging modality in oncologic surgery of the liver, kidneys and pancreas. The ability to detect and characterize small lesions and the precise intraoperative localization of such tumors is essential for adequate surgical planning in segmental or lobar hepatic resections, metastasectomy, nephron-sparing surgery, and partial pancreatectomy. Also, diagnostic characterization of small equivocal lesions deemed indeterminate by conventional preoperative imaging such as multidetector computed tomography or magnetic resonance imaging, has become an important application of IOUS. This article will review the current applications of IOUS in the liver, kidneys and pancreas.     

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

The goal in brain tumor surgery is to remove the maximum achievable amount of the tumor, preventing damage to “eloquent” brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been introduced, including an operating microscope in the late 1950s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resection cavity and thus overcome this remaining uncertainty of intraoperative MRI in high grade brain tumor resection.     

Intraoperative contrast-enhanced ultrasound in traumatic brain surgery

ObjectiveThe objective was to assess intraoperative contrast-enhanced ultrasound (CEUS) in traumatic brain surgery.MethodsWe prospectively performed intraoperative conventional ultrasound (IOUS) and CEUS in 32 patients who underwent emergency surgery for the treatment of traumatic brain injury (TBI). Sonographic appearance including echogenicity, border, and size of the traumatic lesion and adjacent brain tissue on CEUS were compared with those on IOUS using surgical results as the gold standard. The differences in the size and contrast enhancement parameters of the lesions between IOUS and CEUS were analyzed with a paired t test.ResultsThe accuracy of CEUS in assessing TBI was 100%, whereas IOUS was 51%. The absolute peak intensity (API) varied depending on the severity of brain injury. Lower API was observed in severely damaged brain tissue, whereas high API was seen in normal brain tissue or the brain tissue with mild injury. The border of the trauma lesion was more clearly defined on CEUS when compared to IOUS. The size of the lesions measured on CEUS was significantly larger than that on IOUS (P< .01). Importantly, small vessels supplying blood to the tissue in traumatic lesions, as an indication of possible brain vitality, were optimized on CEUS during the surgery. Based on the parameter of time intensity curve and appearances of the lesions on CEUS, the severity of lesions was reclassified and surgical intervention was redesigned in 21 (21/32, 66%) cases.ConclusionIntraoperative CEUS improves accuracy in classification of traumatic brain injury, which helps neurosurgeons to effectively remove hematoma, preserve normal brain tissue, and prevent damaging the vessels during surgical intervention.     

超声诊断腮腺肿块的临床价值

目的探讨超声对腮腺肿块的诊断价值。方法回顾分析52例腮腺肿块超声特点,并与术后病理结果对照。结果超声对腮腺肿块病灶的显示率为100%。对腮腺良性肿块诊断符合率85%,恶性肿块66%。结论超声对腮腺肿块的诊断及鉴别诊断具有可靠、方便的优势。     

High-frequency ultrasound in the study of male breast palpable masses

PURPOSE: To evaluate the role of high frequency colour-Doppler ultrasound in the study of diffuse or local breast nodules in males, and compare these results with those of mammography. MATERIALS AND METHODS: We studied 105 men aged between 12 and 82 years (mean age 42.3 years) with a palpable breast mass with or without pain. All patients underwent clinical and ultrasound examination. Seventy-eight also underwent mammography, whereas 27 did not because of young age (under 25 years) (n=10), no clinical or sonographic suspicion of a malignant mass (n=16), and ulcerated neoplastic lesion (n=1). The final diagnosis derived from surgery in six patients and from three-year follow-up for 99 patients. RESULTS: Eighty-nine patients had gynecomastia (85%), nine had adipomastia (8%), one had fibrolipoma (1%), five had carcinoma (5%) (invasive ductal carcinoma in four and bifocal ductal carcinoma and lobular carcinoma in one patient) and one had liposarcoma (1%). The clinical examination detected a bilateral (n=66) or unilateral (n=39) breast mass. Ultrasonography provided the correct diagnosis of diffuse nodular pathology in all cases and orientated diagnosis towards malignancy (6 cases) or benignity (1 case) of the lesions. No additional information was obtained from mammography, as compared to high-frequency ultrasonography. The integration of colour-Doppler in the examination was of little use as it demonstrated extensive vascularisation of most (5 cases) of the malignant lesions. CONCLUSIONS: Our results indicate that ultrasound allows the detection and characterization of palpable breast masses as well as correct local staging of neoplasms by identifying the degree of infiltration of the surrounding tissues.